(ENG) Sexually Transmitted Infections Guide for Medical Students and Healthcare Professionals

8. Hassab Laboratories 9. ElBordiny Laboratories 10..El Mokhtabar Laboratories 11. Mabaret El Asafra Laboratories 12. Royal Laboratories

Stigma and discrimination against people living with HIV and other STIs Stigma: It is a shame attached to something regarded as socially unacceptable, sometimes there is an internal feeling of shame called self-stigmatization that the person is already battling.

Discrimination: Any measure or action involving a form of distinction among people based on gender, age or a confirmed/suspected health status.

Importance of language: Over the years, repeatedly hearing language still carries with it the stigma and discrmination many people face throughout the years so it is vital to replace negatively-associated phrases and words when it comes to communicating with those living with STIs.

Replace certain words with other more positive ones: - Instead of “AIDS victim/ AIDS carrier/ HIV patient”, use “Person living with HIV” - Instead of “ STI patient”, use “Person living with an STI” - Instead of “Drug/Substance user”, use “Person who uses substance(s)” - Instead of “Former addict”, use “Person in recovery”

Discriminatory actions Instead of double gloving when taking a pulse, try to not wear gloves during casual contact with those who live with HIV or other STIs. (HIV only spreads through blood, semen, pre-seminal, rectal, vaginal fluids and breast milk.)

Instead of trying to minimize contact with, or care of, patients living with HIV, delay or deny treatment, demand additional payment for services and isolate people living with HIV from other patients, try to treat them with the same care and respect any other person receives.

always

Treat with empathy CONTRIBUTORS: Alaa Mokbel Tokka Shaban Maram Osama Dina Abdel Hamid Ahmed Abdel Kader Abdelrahman Mamdouh

STIs Sexually-Trasmitted Infections Guide for Medical Students & Healthcare Professionals

Sexual history-taking A sexual history needs to be taken during a person’s first visit, routine preventive exams, and when a person presents with signs or symptoms consistent with a sexually transmitted infections Here are necessary do(s) and don’t(s) points that should be done at each meeting:

DO(s): - Creating a friendly, safe and judgment free environment for all patients.

- Person’s name and the way they would prefer to be addressed should be asked.

- Provide assurance of confidentiality.

- Ask open-ended (then, clarify by close-ended questions), specific and understandable questions.

- Being patient and attentive when listening.

- Describe how screening tests, results and other resources will be delivered.

- Pay attention to body language: facial expressions, body movement, tone of voice, posture, gesture and eye contact for any signs of discomfort.

DON’T(s): - Avoid assumptions when it comes to a person's behavior, appearance or way of speaking.

- Don’t use intense medical phrases and terms without at least explaining them.

- Avoid using judgemental words, tone of

voice or body language.

- If at any certain point, the person does not feel comfortable, DON’T push further, they can express their answers at their own time (in multiple visits) or the extent of details they feel comfortable in sharing at the moment.

- If you notice the person is experiencing signs of domestic or intimate partner violence, don’t ask “are you a victim of a violence?”

This will only make the person resist your help and will cause more harm than help.

Instead, treat the main cause of concern, ask if there's anything else the person would like to discuss further or any worries they have at the moment and highlight the confidentiality and safety of your office.

Remember, it is a conversation…

NOT a lecture or an interrogation!

Physicians should greet the person in a friendly manner, take consent for any examination & ask for permission before taking notes.

Sexual history can be guided by asking questions in the following categories: 1) Partners 2) Practices 3) Ways of protection from STIs 4) Past history of STIs 5) Pregnancy intentions 6) Additional questions to identify hepatitis risk

After taking the sexual history:

1. Ask if they have any further questions.

2. Thank the patient for being open, honest and commend any protective practises.

3. For patients at risk of STIs, encourage testing and offer praise for protective practices.

Examination of sensitive areas:

1- Voluntary consent should be given.

2- Explain the procedure to the patient in full detail.

3- Privacy to dress and undress.

4- Provide gowns for adequate coverage.

5- Only expose parts that need to be examined and try doing it as fast as possible.

6- If a patient withdraws his/her consent at any time you should stop the examination immediately.

7. Limit the number of people in the room but if the patient is more comfortable with a nurse or a companion then, they should be with him/her.

STIs Screenings & Tests They are important procedures that should be taken at least once a year according to the risk level so infection doesn't spread between others and to protect their partners.

STIs screening is recommended for those at high risk. This includes people: - With an STI-infected partner.

- With more than one partner.

- Having unsafe intercourse.

- Using IV drugs

The following hospitals and laboratories provide testing for STIs in Alexandria: 1. Caritas Egypt 2. Fever Hospital 3. Alexandria University Main Hospital 4. New Alexandria University Hospital 5. El Miri Hospital 6. Medical Research Institute 7. Alfa Laboratories